Abstract
Introduction. Calcium channel blockers (CCBs) drugs are widely used in the treatment of cardiovascular diseases. CCB poisoning is associated with significant cardiovascular toxicity and is potentially fatal. Currently, there is no specific antidote and the treatment of CCB poisoning is supportive; however, this supportive therapy is often insufficient. We present a clinical case of severe diltiazem poisoning and the therapeutic approaches that were used. Case Report. A 55-year-old male was admitted to the intensive care unit (ICU) after voluntary multiple drug intake, including extended release diltiazem (7200 mg). The patient developed symptoms of refractory shock to conventional therapy and required mechanical ventilation, a temporary pacemaker, and renal replacement therapy. Approximately 17 hours after drug intake, hyperinsulinaemia-euglycaemia with lipid emulsion therapy was initiated, followed by progressive haemodynamic recovery within approximately 30 minutes. The toxicological serum analysis 12 h after drug ingestion revealed a diltiazem serum level of 4778 ng/mL (therapeutic level: 40–200 ng/mL). Conclusions. This case report supports the therapeutic efficacy of hyperinsulinaemia-euglycaemia and lipid emulsion in the treatment of severe diltiazem poisoning.
Highlights
Calcium channel blockers (CCBs) drugs are widely used in the treatment of cardiovascular diseases
Calcium channel blockers overdose can cause life-threatening effects, such as bradycardia, atrioventricular (AV) block, hypotension, metabolic acidosis, and shock that is often refractory to conventional therapy
We hereby present a clinical case of a patient with severe diltiazem poisoning in which hyperinsulinaemia-euglycaemia and lipid emulsion therapy contributed to haemodynamic stabilisation
Summary
Diltiazem is a nondihydropyridine L-type calcium channel blocker (CCB) which is widely used in the treatment of cardiovascular diseases. The importance of hyperinsulinaemia-euglycaemia and lipid emulsion therapy has recently been recognised in the treatment of these patients [4,5,6,7,8,9,10,11,12]. These approaches are used as late salvage therapy in cases of CCB poisoning when other measures have failed. We hereby present a clinical case of a patient with severe diltiazem poisoning in which hyperinsulinaemia-euglycaemia and lipid emulsion therapy contributed to haemodynamic stabilisation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
